Ping Xu

Background: The shift of cancer care to the home setting via oral anticancer therapy has introduced significant challenges to continuity of care and patient safety. Despite its promise, there remains a lack of comprehensive research that characterizes the components of pharmacist interventions and evaluates their impact on clinical outcomes and quality indicators across the continuity of care. Methods: This review searched PubMed, EMBASE, and Web of Science from inception to December 2024, including studies that implemented pharmacist-led interventions for patients receiving oral anticancer therapy and reported at least one outcome measure in economic, clinical, or humanistic domains. A meta-analysis was conducted using R, calculating the mean difference effect size for continuous outcomes and the odds ratio for dichotomous outcomes. Results: A total of 27 studies evaluating pharmacist-led interventions in patients receiving oral anticancer therapy were identified through systematic searches, including randomized controlled trials, non-randomized controlled trials, and cohort studies. The study identified 11 pharmacist interventions distributed across four main domains, namely patient education and behavioral support, symptom and toxicity management, medication therapy management, and healthcare access support. The meta-analysis revealed that pharmacist interventions tend to improve medication adherence and treatment persistence. However, the impact on clinical endpoints and the incidence of drug-related problems remained heterogeneous. Evidence regarding their impact on economic burden, quality of life, health beliefs and knowledge remained limited. Conclusions: Pharmacist-led interventions may contribute to quality indicators, specifically treatment adherence and persistence in oral anticancer therapy management. While these improvements are associated with patient safety and treatment effectiveness, current evidence is insufficient to confirm a direct translation into superior clinical endpoints. Further studies are needed to confirm the effectiveness of pharmacist-led interventions in cancer patients and to comprehensively evaluate the value of continuity of care.

Background: Evidence-based physician-pharmacist collaborative clinics have demonstrated significant short-term benefits for patients with type 2 diabetes (T2D), but their long-term effectiveness remains unclear, especially in primary health care settings. Objective: This study aimed to explore the long-term effectiveness and cost-effectiveness of a novel, digital-driven, multifaceted physician-pharmacist collaborative model for managing patients with T2D in underresourced settings. Methods: We conducted a 12-month cluster randomized controlled trial from May 2021 to December 2022 across 6 primary health care settings in China. Guided by the theory of planned behavior, the intervention involved routine therapy from physicians along with pharmaceutical interventions from pharmacists. These were delivered through a combination of face-to-face visits and mobile health care. The intervention group received 4 face-to-face visits and biweekly remote education sessions over the 12 months. We conducted intention-to-treat analyses to estimate differences in clinical and behavior indicators between the intervention and control groups. Primary outcomes included glycosylated hemoglobin and 10-year atherosclerotic cardiovascular risk. Data were analyzed using adjusted generalized estimation equations. Results: This study included 574 patients (291 in the intervention group and 283 in the control group). Over 12 months, patients in the intervention group had significant reductions in hemoglobin A1c (–2.57 vs –1.96, respectively; P<.001; 95% CI –1.027 to –0.238) and 10-year atherosclerotic cardiovascular risk (–1.35 vs 0.01, respectively; P<.001; 95% CI –1.690 to –0.630) compared with the control group. Substantial improvements were also observed in several secondary outcomes, including fasting blood glucose, 2-hour postprandial blood glucose, waist circumference, waist-to-hip ratio, blood pressure, triglyceride, and total cholesterol. Total diabetes-related costs decreased, and patient satisfaction improved significantly in the intervention group. There were no significant differences in BMI, high-density lipoprotein, or low-density lipoprotein. Conclusions: These findings suggest that the physician-pharmacist collaborative model could improve the long-term quality and efficiency of T2D management and reduce medical costs in underresourced areas globally. Patients with T2D, especially those with central obesity or high cardiovascular risk, may benefit more from collaborative clinics. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000031839; https://www.chictr.org.cn/showproj.html?proj=51910

Introduction: Clinical pharmacy services comprise a range of patient‐centered, systematic care activities delivered by pharmacists, aiming to optimize medication use and improve patient outcomes. Despite growing recognition of the role of clinical pharmacy in medication safety, there is limited comprehensive analysis of barriers or actionable strategies, especially in under‐resourced areas. This study aims to explore the state of implementation of clinical pharmacy practice, to elucidate the influencing factors and associated strategies. Methods: Data were collected through quantitative surveys, participant observation, and semi‐structured interviews. Data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR). Directed content analysis was used to code the data and identify factors influencing clinical pharmacy services. Implementation strategies were developed using the CFIR‐ERIC matching tool. Results: Case studies were conducted in six county hospitals, with a total of 64 interviewees. We identified 25 facilitators and 21 barriers across five CFIR domains, with 15 distinguishing constructs between well and poorly performing centers. Our findings highlighted the critical role of local condition, policies and laws, external support, standardized appraisal systems, leadership, available resources, staffing and performance‐linked incentives in sustaining service quality. Our analysis also proposed 8 tailored strategies to support sustainable implementation. The main distinguishing constructs between well and poorly performing implementation centers included outer setting, inner setting, individuals and implementation process. Conclusions: The implementation and sustainability of clinical pharmacy services are still limited by factors such as inadequate resources, inappropriate regulatory frameworks, lack of leadership, and insufficient competency of pharmacists. Corresponding implementation strategies should be adopted to promote the development of clinical pharmacy services, and the professional development of clinical pharmacists, especially in under‐resourced areas. Clinical Trial Registration: N/A.

Background: Clinical pharmacy services have gained high recognition worldwide, but are still unevenly developed and inequitable. This study aims to explore the setting and implementation of clinical pharmacy services in county hospitals in China and to identify the associated factors, as well as the perceptions and demands of healthcare professionals.Methods: A national cross‐sectional survey of clinical pharmacy services in county hospitals in China from April to October 2023. Data were obtained from questionnaire surveys of stakeholders including leaders of pharmacy departments, pharmacists, doctors, and nurses in county hospitals in China. Data was analyzed using descriptive statistics, chi‐square test, t‐test and Wilcoxon rank sum test.Results: A total of 1510 questionnaires were collected from 362 county hospitals in 15 provinces in China. The median number of clinical pharmacists in county hospitals was 3 (2−5), far less than the requirement. More than 80% of the hospitals have established working mode and procedures of clinical pharmacy services, but only around 30% of them have incentive policy and charge for services. At present, over 60% of county hospitals consistently provide prescription review. Clinical pharmacy services significantly contributed to the rational use of medication and were highly valued by both doctors and nurses.Conclusion: The findings indicated that clinical pharmacy services were embedded into daily work of clinical pharmacists, which was highly recognized by healthcare professionals. However, the implementation and sustainability of these services in county hospitals are still restricted by inadequate resources, incomplete systems, and insufficient competence.

BACKGROUND Evidence-based physician-pharmacist collaborative clinics have demonstrated significant short-term benefits for patients with type 2 diabetes (T2D), but their long-term effectiveness remains unclear, especially in primary health care settings. OBJECTIVE This study aimed to explore the long-term effectiveness and cost-effectiveness of a novel, digital-driven, multifaceted physician-pharmacist collaborative model for managing patients with T2D in underresourced settings. METHODS We conducted a 12-month cluster randomized controlled trial from May 2021 to December 2022 across 6 primary health care settings in China. Guided by the theory of planned behavior, the intervention involved routine therapy from physicians along with pharmaceutical interventions from pharmacists. These were delivered through a combination of face-to-face visits and mobile health care. The intervention group received 4 face-to-face visits and biweekly remote education sessions over the 12 months. We conducted intention-to-treat analyses to estimate differences in clinical and behavior indicators between the intervention and control groups. Primary outcomes included glycosylated hemoglobin and 10-year atherosclerotic cardiovascular risk. Data were analyzed using adjusted generalized estimation equations. RESULTS This study included 574 patients (291 in the intervention group and 283 in the control group). Over 12 months, patients in the intervention group had significant reductions in hemoglobin A1c (–2.57 vs –1.96, respectively; P<.001; 95% CI –1.027 to –0.238) and 10-year atherosclerotic cardiovascular risk (–1.35 vs 0.01, respectively; P<.001; 95% CI –1.690 to –0.630) compared with the control group. Substantial improvements were also observed in several secondary outcomes, including fasting blood glucose, 2-hour postprandial blood glucose, waist circumference, waist-to-hip ratio, blood pressure, triglyceride, and total cholesterol. Total diabetes-related costs decreased, and patient satisfaction improved significantly in the intervention group. There were no significant differences in BMI, high-density lipoprotein, or low-density lipoprotein. CONCLUSIONS These findings suggest that the physician-pharmacist collaborative model could improve the long-term quality and efficiency of T2D management and reduce medical costs in underresourced areas globally. Patients with T2D, especially those with central obesity or high cardiovascular risk, may benefit more from collaborative clinics. CLINICALTRIAL Chinese Clinical Trial Registry ChiCTR2000031839; https://www.chictr.org.cn/showproj.html?proj=51910

Cyclosporine is a potent immunosuppressive drug for various immune-mediated diseases in children. Cyclosporine’s expected therapeutic effect also carries a wide range of side effects. One of the most common and intriguing dermatological side effects is hypertrichosis. However, recent reports have recognized alopecia as a potential adverse effect of cyclosporine. Here, we report a case of a 29-month-old boy diagnosed with aplastic anemia. During cyclosporine therapy, the patient presented with hair loss on the scalp, which and subsequently spread to the eyebrows and eyelashes. The alopecic symptoms were not relieved following topical minoxidil liniment interventions. When the cyclosporine was discontinued, a remarkable improvement was observed in the scalp, with complete hair regrowth. Data concerning cyclosporine from the FDA Adverse Event Reporting System (FAERS) database were extracted from January 2004 to January 2023. Within FAERS, our post-marketing pharmacovigilance analysis detected the reporting association of cyclosporine and alopecia. In monotherapy, cyclosporine-induced alopecia was observed in 118 cases, and tacrolimus-induced alopecia signals were detected in 197 cases. Although the potential mechanism of medication-induced hair loss is unclear, we identified a potential correlation between alopecia and cyclosporine, and it is still necessary to adequately recognize and clinically monitor this paradoxical reaction.

Background: Although physician-pharmacist collaborative clinics for diabetes management have been shown to be effective and cost-effective worldwide, there is limited understanding of the factors that influence their sustainable implementation. This study aims to identify the associated factors and provide sustainability strategy to better implement physician-pharmacist collaborative clinics for diabetes management in primary healthcare centers in China. Methods: A sample of 43 participants were participated in face-to-face, in-depth, semi-structured interviews. Consolidated Framework for Implementation Research was used to identify facilitators and barriers to implementing physician-pharmacist collaborative clinics for diabetes management in primary healthcare centers, and to explore discriminating factors between low and high implementation units. A sustainable strategy repository based on dynamic sustainability framework was established to inform further implementation. Results: This study demonstrated that clear recognition of intervention benefits, urgent needs of patients, adaptive and tailored plan, highly collaborative teamwork and leadership support were the major facilitators, while the major barriers included process complexity, large number and poor health literacy of patients in primary areas, inappropriate staffing arrangements, weak financial incentives and inadequate staff competencies. Six constructs were identified to distinguish between high and low implementation units. Sixteen strategies were developed to foster the implementation of physician-pharmacist collaborative clinics, targeting Intervention, Practice setting, and Ecological system. Conclusion: This qualitative study demonstrated facilitators and barriers to implementing physician-pharmacist collaborative clinics for diabetes management in primary healthcare centers and developed theory-based strategies for further promotion, which has the potential to improve the management of diabetes and other chronic diseases in under-resourced areas.

Background: Physician-pharmacist collaboration is a well-established care mode for the management of type 2 diabetes mellitus (T2DM) in developed countries, but no study has been conducted in primary healthcare in China. This study aims to evaluate the effects of physician-pharmacist collaborative clinics to manage T2DM in primary healthcare in China, and to better understand the factors influencing the implementation of physician-pharmacist collaborative clinics.Methods: Two hundred and sixty-seven patients involved in a 12-month randomized controlled trial were assigned to physician-pharmacist collaborative clinics and usual clinics, completing surveys regarding medication compliance, quality of life (QoL) and care-seeking behavior at the baseline, 3rd, 6th, 9th and 12th month respectively, and diabetes knowledge at baseline and 12th month. A sample of twenty-two Patients, nine physicians and twelve pharmacists participated in semi-structured face-to-face interviews. The quantitative and qualitative data was integrated by triangulation.Results: Patients in physician-pharmacist collaborative clinics had significant improvements in medication compliance (p = 0.009), QoL (p = 0.036) and emergency visits (p = 0.003) over the 12-month. Pairwise comparison showed the medication compliance score in the intervention group had been significantly improved at 3rd month (p = 0.001), which is more rapidly than that in the control group at 9th month (p = 0.030). Factors influencing the implementation of physician-pharmacist collaborative clinics were driven by five themes: pharmaceutical service, team-base care, psychological support, acceptability of care and barriers to implementation.Conclusion: Integration of quantitative and qualitative findings showed the effectiveness of physician-pharmacist collaborative clinics in patient medication compliance and QoL in primary healthcare. The qualitative study uncovered barriers in insufficient clinical experience and understaffing of pharmacist. Therefore, the professional training of the primary pharmacist team should be improved in the future.Clinical Trial Registration:clinicaltrials.gov, identifier ChiCTR2000031839.